HomeMy WebLinkAbout0176 -
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gyd'""''~~ - STATE OF NEW .IERSEY
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~ OFFICE OF REGISTRAR OF VtTAL STATI5TIG5 _
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of Ventnor Citya...Atl.antic,.Count~ `
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GT1f. /OtOYaX OIt TONNSNir 11NO OOYNTY .
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i . Tbif is to certif
j that the following ~s correctly copied trom a reoord of Death in my offioa.
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~ NAME OF DECEASEO PLACE OF OHATH DATE OF DEATH ;
~ _J. MATHTS BLOODGOOD Atlantic City, N.J. 10/13/74 ~
~ SOCIAL SECURITY NUMBER SEX. COLOR MARITAI CONDITtON OATE OF BIRTH AGE !
YRS. MOS. Ol1Y ~
~ male white married 9/23/1913 61 `
PLACE OF BIRTM CAUSE OF DHATH
New Jersey Acute coronary occlusion
~ SUPPLEMENTAL INFORMATION IF OEATH WAS OUE TO.EXTERNAL CAUSES '
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~ ACCiDENT. SUICIDE OR HOMICIDE DATE OF OCCURRENCE
SPECIFY i. _
~ WHERE OID INJURY OCGURf
~ CITY OR TONN COUNTY , STATE
~ DIO INJURY OGCUR IN OR ABOUT HOME. ON FARM. IN INOU57RIAL PI.AGE, IN PUBLIC PLAGEt `
~ SPECIFY TYPE OF PLACE f
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WHILE AT ~ORKT MEANS OF INJURY
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~ NAME OF PERSON rIIHO CERTIFIE~ CAUSE OF DEATH ADDRESS
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Dr. William A. Joy ~ Vent or, N.J.
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~ It Ci t~„ Hall,~ Ventnora,,,,, ,,,~T,~,,,,,,,,,,,,,,,,
~ Z PH'~ Ada~
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~ i~1151..?~ ~ ~ ~
~ Date o~ Issne Q R~~ '
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~ s.N. so~N
~ UtHtR TU/LIfHING CO , INC., TIKNTON, N. J. ~
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